Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Br J Sociol ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31912495

RESUMO

This paper explores temporal constituents of the female self in terms of their role in underpinning ongoing gender inequality. Drawing on the work of Simone de Beauvoir and Iris Marion Young, together with sociological approaches to ambivalence, I suggest that these temporal subjectivities are embodied, arise from the split subjectivity associated with woman as simultaneously subject and object, and counterpose the neoliberal emphasis on "choice" and agency with a more traditional gendered "expectation," or "waiting" style. The dialectic between both temporalities, in which neither is hegemonic, results in a chronic state of ambivalence which impedes women's ability to fully project themselves into the future, a skill significant to planning and career ambition and the absence of which suspends women instead in an extended present. The paper aims to do two things in particular. In conceptual terms it aims to explore aspects of the configuration of the gendered self that underlie the stalling and slowing down of the gender revolution and which can be seen to provide a "missing link" between structures, institutions, and micro-cultures. In empirical terms, it suggests a future research agenda, of which this paper constitutes a beginning, through which such gendered temporalities can be explored in greater detail via ethnographies of women's lived experience of time throughout the life course.

2.
J Aging Stud ; 49: 56-65, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31229219

RESUMO

Understanding of the latter part of the life course in age studies takes place largely through the lens of the third and fourth ages. Counterposing successful ageing with the failure of the fourth age, there is little conceptual room for the possibility of paradox or the co-existence of good and bad, gain and loss. Sociological studies of the life course also gives little attention to embodied subjectivity, focusing rather on structural and material aspects of inequality. All of these factors mean that women's experience in moving through the life course is inadequately conceptualised. In this paper I suggest an alternative feminist framework for the life course building on the work of Simone de Beauvoir and focusing particularly on the concept of the third sex. The paper is structured as follows. After introducing the need to construct an alternative, feminist life course framework, I review the texts and countertexts that represent women's ageing alternatively in negative and positive tones. I then turn to Beauvoir's work, focusing particularly on the 'third sex' concept as a means of mediating the embodied experience of later life. I then use it to illuminate women's accounts of their lived experience, via three themes: bodily changes; narratives and plots; and sexuality. Overall the paper seeks to show that that new insights introduced by the third sex concept can enrich cultural gerontology whilst both age and gender studies will benefit by being brought into closer alignment.

3.
Age Ageing ; 48(4): 466-471, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31220205

RESUMO

In the past decade, frailty research has focused on refinement of biomedical tools and operationalisations, potentially introducing a reductionist approach. This article suggests that a new horizon in frailty lies in a more holistic approach to health and illness in old age. This would build on approaches that view healthy ageing in terms of functionality, in the sense of intrinsic capacity in interplay with social environment, whilst also emphasising positive attributes. Within this framework, frailty is conceptualised as originating as much in the social as in the biological domain; as co-existing with positive attributes and resilience, and as situated on a continuum with health and illness. Relatedly, social science-based studies involving interviews with, and observations of, frail, older people indicate that the social and biographical context in which frailty arises might be more impactful on the subsequent frailty trajectory than the health crisis which precipitates it. For these reasons, the article suggests that interpretive methodologies, derived from the social sciences and humanities, will be of particular use to the geriatrician in understanding health, illness and frailty from the perspective of the older person. These may be included in a toolkit with the purpose of identifying how biological and social factors jointly underpin the fluctuations of frailty and in designing interventions accordingly. Such an approach will bring clinical approaches closer to the views and experiences of older people who live with frailty, as well as to the holistic traditions of geriatric medicine itself.

4.
J Aging Stud ; 47: 24-31, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30447866

RESUMO

The aim of this paper is to subject the clinical classification of frailty to scrutiny through exploring, via a phenomenological lens, the lived experiences of older people who meet the objective, or clinical, criteria of frailty. Drawing on a range of published research that explores the heterogeneous experiences of embodied ageing, the paper highlights the continuity of phenomenological structures of experience across successful ageing, normal ageing and frailty, suggesting the permeability and contestability of the boundaries between them and highlighting the complexity of health and illness in old age. Such data suggests a need to question the perception of frailty as something both apart from 'normal' ageing, and constitutive of frailed or failed ageing, and challenges the construction of the third age/fourth age polarity that underpins much of the meaning accorded to old age today.


Assuntos
Envelhecimento , Idoso Fragilizado , Fragilidade , Idoso de 80 Anos ou mais , Humanos , Pesquisa Qualitativa
5.
Sociol Health Illn ; 36(4): 549-63, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-25650444

RESUMO

Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally.


Assuntos
Envelhecimento , Idoso Fragilizado , Geriatria , Idoso , Idoso de 80 Anos ou mais , Política de Saúde , Humanos , Reino Unido
6.
Sociol Health Illn ; 32(7): 1072-86, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20649892

RESUMO

This paper examines the professionalising of geriatric medicine in the UK roughly between the 1940s and the 1970s and locates it in terms of the broader context of the relationship between the professions and the state. It looks at how this relationship shaped geriatric medicine's professional jurisdiction, including the discourses of expertise on the one hand and the constituting of the 'subjects' of such expertise on the other. In contrast to other sociological approaches to the professions, which highlight the negative impact of state encroachment on professional territory, this paper contends that without the backing of the Ministry of Health the specialty may never have established itself in the face of prolonged opposition from rival specialists. However, such support was predicated on the specialty's highlighting particular legitimating discourses and practices at the expense of others, and in framing this in terms of specific policy concerns around an ageing population. Whilst this imprinted the profession with the stamp of governmentality, it also contributed to the broader problematising of old age in the twentieth century. The paper concludes by considering the legacy of this context of professionalisation for the profession today.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde para Idosos/legislação & jurisprudência , Papel Profissional/história , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Clínicos Gerais/legislação & jurisprudência , Serviços de Saúde para Idosos/história , História do Século XX , História do Século XXI , Humanos , Preconceito , Competência Profissional/legislação & jurisprudência , Medicina Estatal , Reino Unido
7.
J Health Serv Res Policy ; 14(2): 88-95, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19299262

RESUMO

OBJECTIVE: To assess the impacts of different forms of case management for people aged over 65 years at risk of unplanned hospital admission, in particular the impacts upon patients, carers and health service organization in English primary care; and, in these respects, compare the Evercare model with alternatives. METHODS: Multiple qualitative case studies comparing case management in nine English Primary Care Trusts which piloted the Evercare model of case management and four sites which implemented alternative forms of case management between 2003 and 2005. Data were obtained from 231 interviews with patients, carers and other key informants, and from content analysis of documents and observation of meetings. RESULTS: All the projects established functioning case management services, but none led to major service reorganization or savings elsewhere in the health care system. Many informants reported examples of admissions which case management had prevented, but overall hospital admissions did not significantly change, possibly due to increased case-finding. Patients and carers valued case management for improving access to health care, increasing psychosocial support and improving communication with health professionals. CONCLUSION: Case management was highly valued by patients and their carers, but there were few major differences in outcomes between Evercare and other models.


Assuntos
Administração de Caso , Idoso , Idoso de 80 Anos ou mais , Administração de Caso/normas , Inglaterra , Serviços de Assistência Domiciliar , Hospitalização , Hospitais Públicos , Humanos , Entrevistas como Assunto , Modelos Organizacionais , Casas de Saúde , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa
8.
J Health Serv Res Policy ; 13(4): 233-9, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18806182

RESUMO

OBJECTIVES: To assess the likely impact on patients and local health economies of shifting specialist care from hospitals to the community in 30 demonstration sites in England. METHODS: The evaluation comprised: interviews with service providers at 30 sites, supplemented by interviews with commissioners, GPs and hospital doctors at 12 sites; economic case studies in six sites; and patient surveys at 30 sites plus at nine conventional outpatient services. Outcomes comprised: staff views of service organization and development, impact on primary and secondary care, and benefits for patients; cost per consultation and cost per patient in new services compared to estimates of the price of services if undertaken by hospitals; patients' views of waiting time, access, quality (technical and interpersonal), coordination and satisfaction. RESULTS: New services required high initial investment in staff, premises and equipment, and the support of hospital consultants. Most new services were added to existing hospital services so expanded capacity. Patient reported waiting times (6.7 versus 10.1 weeks; p = 0.001); technical quality of care (96.2 versus 94.5; p < 0.001), overall satisfaction (88.2 versus 85.4; p = 0.04); and access (72.2 versus 65.8; p = 0.001) were significantly better for new compared to conventional services but there was no significant difference in coordination or interpersonal quality of care. Some service providers expressed concerns about service quality. New services dealt with less complex conditions and undercut the price tariff applied to hospitals thus providing a cost saving to commissioners. There was some concern that expansion of new services might destabilize hospitals. CONCLUSIONS: Moving specialist care into the community can improve patient access, particularly when new services are added to existing hospital services. Wider impacts on health care quality, capacity and cost merit closer scrutiny before rollout.


Assuntos
Medicina , Área de Atuação Profissional , Especialização , Humanos , Entrevistas como Assunto , Inovação Organizacional , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
9.
Health Soc Care Community ; 15(6): 511-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17956403

RESUMO

Nurse-led case management programmes have become increasingly popular over the last 15 years. Countries such as the USA, Canada, Sweden and the Netherlands have long running case management programmes in place for frail elderly people. The Department of Health in England has recently introduced a 'community matron' role to provide case management to patients with highly complex long-term conditions; a group that is predominantly comprised of elderly people. Department of Health policy documents do not define the day-to-day role of community matrons but instead describe the objectives and principles of case management for long-term conditions. The aim of this qualitative study was to describe case management from the perspective of patients and carers in order to develop a clearer understanding of how the model is being delivered for patients with long-term conditions. In-depth interviews were conducted with a purposive sample of 72 patients and 52 carers who had experience of case management. Five categories of case management tasks emerged from the data: clinical care, co-ordination of care, education, advocacy and psychosocial support. Psychosocial support was emphasised by both patients and carers, and was viewed as equally important to clinical care. Patient and carer perceptions of case management appear to contrast with descriptions contained in Department of Health guidance, suggesting an 'implementation surplus' in relation to the policy. This particularly appears to be the case for psychosocial support activities, which are not described in official policy documents. The provision of significant psychosocial support by community matrons also appears to differentiate the model from most other case management programmes for frail elderly people described in the literature. The findings emphasise the importance of seeking patient and carer input when designing new case management programmes.


Assuntos
Administração de Caso/organização & administração , Satisfação do Paciente , Humanos , Entrevistas como Assunto , Assistência de Longa Duração , Casas de Saúde , Reino Unido
10.
BMJ ; 334(7583): 31, 2007 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-17107984

RESUMO

OBJECTIVES: To determine the impact on outcomes in patients of the Evercare approach to case management of elderly people. DESIGN: Practice level before and after analysis of hospital admissions data with control group. SETTING: Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission. MAIN OUTCOME MEASURES: Rates of emergency admission, emergency bed days, and mortality from April 2001 to March 2005 in 62 Evercare practices and 6960-7695 control practices in England (depending on the analysis being carried out). RESULTS: The intervention had no significant effect on rates of emergency admission (increase 16.5%, (95% confidence interval -5.7% to 38.7%), emergency bed days (increase 19.0%, -5.3% to 43.2%), and mortality (increase 34.4%, -1.7% to 70.3%) for a high risk population aged >65 with a history of two or more emergency admissions in the preceding 13 months. For the general population aged > or =65 effects on the rates of emergency admission (increase 2.5%, -2.1% to 7.0%), emergency bed days (decrease -4.9%, -10.8% to 1.0%), and mortality (increase 5.5%, -3.5% to 14.5%) were also non-significant. CONCLUSIONS: Case management of frail elderly people introduced an additional range of services into primary care without an associated reduction in hospital admissions. This may have been because of identification of additional cases. Employment of community matrons is now a key feature of case management policy in the NHS in England. Without more radical system redesign this policy is unlikely to reduce hospital admissions.


Assuntos
Administração de Caso , Emergências/epidemiologia , Idoso Fragilizado , Serviços de Saúde para Idosos/organização & administração , Idoso , Ocupação de Leitos , Estudos de Casos e Controles , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Inglaterra , Serviços de Saúde para Idosos/normas , Hospitalização , Humanos , Mortalidade , Medicina Estatal/organização & administração , Medicina Estatal/normas , Resultado do Tratamento
11.
Soc Sci Med ; 63(2): 373-83, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16472899

RESUMO

Hirschman contrasts exit and voice as 'recuperation' mechanisms for making organisations responsive to users. However, the emergence of health-care quasi-markets and of network governance structures since Hirschman necessitate revising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs), this paper analyses the recuperation mechanisms, governance structures and relations between them in primary care in England. User voice can be exercised through dedicated networks besides hierarchies. As well as the 'user exit' described by Hirschman, two new 'exit' mechanisms now exist in quasi-markets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund-holder (or analogous budget-holder) behaves similarly. Neither exit mechanism requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of English PCTs illustrates.


Assuntos
Comportamento do Consumidor , Conselho Diretor/organização & administração , Atenção Primária à Saúde/organização & administração , Medicina Estatal/organização & administração , Política de Saúde , Humanos , Objetivos Organizacionais , Reino Unido
12.
J Health Serv Res Policy ; 9(3): 132-8, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15272970

RESUMO

OBJECTIVES: English primary care organisations (primary care groups and trusts - PCGs, PCTs) were, and are, responsible for the quality of general practice but lack hierarchical structures and, frequently, contractual relationships through which to influence it. The theory of soft governance describes how managers can influence professional practice by other means. This study examines the hypothesis that PCG/Ts have used 'soft' clinical governance. METHODS: Survey in 2000/01 of general practitioners' (GPs') attitudes, opinions and self-reported activity in six PCGs and six PCTs using a semi-structured mailed questionnaire. To assess how representative respondents were of English GPs generally, four questions from a national sample survey of English GPs were included and the results compared. RESULTS: Responses were obtained from 437 (52%) GPs. They most often mentioned the technical aspects of clinical governance. Managerial, policy and resourcing implications were next most frequently mentioned, usually in unfavourable terms. Most GPs reported that their clinical practice had changed because of clinical governance activities, although nearly 40% also reported little difference in the quality of care provided. The National Service Framework for coronary heart disease influenced practice independently of PCG/T activities. CONCLUSION: English primary care organisations are exercising soft governance (although not by that name) over some but not all aspects of GPs' clinical practice. However, this soft governance is complex, not easy to sustain and appears hard to extend beyond essentially clinical domains.


Assuntos
Atitude do Pessoal de Saúde , Medicina de Família e Comunidade/normas , Auditoria Médica/organização & administração , Médicos de Família/psicologia , Atenção Primária à Saúde/normas , Tomada de Decisões , Inglaterra , Humanos , Autonomia Profissional , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Medicina Estatal/normas
13.
Br J Gen Pract ; 52(481): 641-5, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12171222

RESUMO

BACKGROUND: It is commony claimed that changing the culture of health organisations is a fundamental prerequisite for improving the National Health Service (NHS). Little is currently known about the nature or importance of culture and cultural change in primary care groups and trusts (PCG/Ts) or their constituent general practices. AIMS: To investigate the importance of culture and cultural change for the implementation of clinical governance in general practice by PCG/Ts, to identify perceived desirable and undesirable cultural attributes of general practice, and to describe potential facilitators and barriers to changing culture. DESIGN: Qualitative: case studies using data derived from semi-structured interviews and review of documentary evidence. SETTING: Fifty senior non-clinical and clinical managers from 12 purposely sampled PCGs or trusts in England. RESULTS: Senior primary care managers regard culture and cultural change as fundamental aspects of clinical governance. The most important desirable cultural traits were the value placed on a commitment to public accountability by the practices, their willingness to work together and learn from each other, and the ability to be self-critical and learn from mistakes. The main barriers to cultural change were the high level of autonomy of practices and the perceived pressure to deliver rapid measurable changes in general practice. CONCLUSIONS: The culture of general practice is perceived to be an important component of health system reform and quality improvement. This study develops our understanding of a changing organisational culture in primary care; however, further work is required to determine whether culture is a useful practical lever for initiating or managing improvement.


Assuntos
Medicina de Família e Comunidade/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Auditoria Médica/organização & administração , Cultura Organizacional , Medicina Estatal/normas , Atitude do Pessoal de Saúde , Medicina de Família e Comunidade/normas , Implementação de Plano de Saúde , Entrevistas como Assunto , Inovação Organizacional , Diretores Médicos/psicologia , Qualidade da Assistência à Saúde/organização & administração , Reino Unido
14.
Health Expect ; 5(3): 187-98, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12199658

RESUMO

OBJECTIVES: To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation. DESIGN: Qualitative data comprising semi-structured interviews, reviews of documentary evidence and relevant literature. SETTING: Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status. PARTICIPANTS: Key stakeholders including Lay Board members (n = 12), Chief Executives (CEs) (n = 12), Clinical Governance Leads (CG leads) (n = 14), Mental Health Leads (MH leads) (n = 9), Board Chairs (n = 2) and one Executive Committee Lead. RESULTS: Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs. CONCLUSIONS: Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself.


Assuntos
Participação da Comunidade , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Programas Nacionais de Saúde/legislação & jurisprudência , Opinião Pública , Reino Unido
15.
Health Soc Care Community ; 10(3): 144-50, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12121250

RESUMO

Care in the community has been constructed on the basis of professional support for carers who, as a result of community care policy that has released highly dependant people from residential care and long-stay wards, are carrying out a wide range of tasks, including complex health care activities. The present paper examines the health care activities currently undertaken by family carers and the way in which they work with, and are supported by, professional nurses in the home. It compares and contrasts the approaches of both groups to care-giving for this client group. The authors conclude by making some suggestions for improving the way in which family carers and nurses work together in the home.


Assuntos
Cuidadores , Enfermagem em Saúde Comunitária/métodos , Idoso Fragilizado , Serviços de Saúde para Idosos , Assistência Domiciliar/métodos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Humanos , Entrevistas como Assunto , Descrição de Cargo , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Relações Profissional-Família , Papel (figurativo) , Reino Unido
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA